Category: Work Conditions

What often annoys me, is when patients think I’m too young, and therefore they perceive that I’m not experienced enough. It doesn’t help that I’ve only just started work as a GP, and every now and then I have to phone up my supervisor for advice. In fact, I probably still am quite inexperienced, but which starting GP registrar isn’t inexperienced? It comes with time, and right now, I’m doing the dam best that I can to improve my knowledge and experience, something which patients can’t appreciate in that 10-20 minute consult that I conduct. Never mind the weekends that I end up spending trying to study up on the cases that I didn’t know much about during the week.

I remember in the first few days of work at my practice, one of the patients said “oh, it seems that doctors are getting younger and younger”. In reality, I feel flattered that I look young for my age (I’m around 28 years old this year), but at the same time, I feel like that me being so young means that the patient won’t have as much confidence in my diagnoses, in my management plans.

Just yesterday, I had a 20 year old patient talk about “closing the gap” program, to which I advised that I wasn’t entirely familiar with it.

“Are you sure you’re a doctor?”. Fed up at this so called “joke” (what an utterly tasteless joke by the way), I shot back matter of fact “Yes, of course I’m a doctor”. From what I make of it, I don’t believe that she would have made such a “joke” if I perhaps looked much older. The fact that I was feeling a little stressed out at the time didn’t help, as the patient mentioned irregular vaginal bleeding. In my mind, I was trying to work out what the best approach was. Thoughts about ruling out pregnancy, ruling out STIs and ordering blood tests swirled through my head. But this patient’s a lesbian. Do I still do a pregnancy test? She seemed the patient that was easily offended, and very crass with her comments. I opted to do some blood tests, and stealthily added a “serum bhcg” to the form.

Being the youngest in the practice (every other doctor has greying hair), it would appear that if patients had a choice, they’d obviously go for the greying hair doctors. I mean, who would trust a young doctor who just started out over someone who’s had 20+ years experience as a doctor right? What they forget though, is that being young and still learning, I’m probably more up to date with the most recent guidelines, more technologically savy as well, and well um, less cynical as well.

But I don’t think all that matters in the 10-20 minute consult. It’s just first impressions. At the end of a consult, if I am able to convey a sense of confidence, an attitude and an approach that seems beyond my years, I hope that the patient won’t just think that I’m too young and inexperienced just based on how I look. That behind the young face is someone who has worked hard, studied hard, and knows what they’re doing to do a great job of treating the patient.

As a GP registrar, I’ve come to see many different things. Some things are straightforward, some are a little more complex. The challenge is being able to manage both fairly well.

For those straightforward cases, they are time savers, and give me that little bit of confidence that I’m doing something right. But those more complicated ones, I end up spending time looking up databases and management guidelines to figure out what to do. And even then, I may still have to speak to my supervisor.

Working today, I got the opportunity to essentially to tell a drug seeker to get lost. Well, not so bluntly, but essentially, I told him “I’m not allowed to prescribe you that”. He ended up saying he’d go to ED (after possibly having a fractured hand because he punched someone yesterday – all in the name of ‘self defence’). Trying to tell this man up straight that I wouldn’t prescribe it was pretty tough I must say. The patient persisted and persisted, but I had to hold my ground and just say no.

My next patient was a woman who came in for review of her test results. Of course, being the curious one and trying to do a thorough job, I had to enquire why the tests were ordered in the first place. It was largely due to hair loss. A quick inquiry into her social background revealed more about her possible hair loss than any blood test could tell. She was having a strained relationship with her daughter, she was essentially cut off from family due to her current partner, and her father was quite ill. My hypothesis is that her hair loss could be from stress. The patient also revealed, that her partner just told her that he was leaving her right before dropping her off at the practice. She broke into tears right in front of me. I offered her some tissues, and tried to advise her about constructive ways of dealing with this difficult event ie don’t drink alcohol, get some exercise, get social etc.

We’re I’m currently working at, I see all sorts of interesting people. Probably because of the low socioeconomic status group that come through. Really, I see a lot of blue collared workers. I could have potentially seen more well off people by working across the road at the mall. But I don’t think I would learn as much, and wouldn’t be made ‘tough’ from the relatively well off people there.

Having come across a variety of people in the last few weeks, I realized that there’s going to be lots of stuff I don’t know. And also lots of people who may not be the most reasonable of people to talk to.

And this is perhaps where I think it’s important for me to stick to my principles. I believe in being respected as a doctor, rather than liked as a doctor. I think I’ll go further if I’m respected, rather than if I’m only liked.

So I can happily say that I survived my first day of being a GP registrar. I stayed back late too, and I wasn’t actually grumpy about that, unlike being in a hospital rotation. Which I thought was quite unusual actually.

After an awesome 2 days at an island resort attending official orientation with the GP training organization, I was a little apprehensive about starting today. Thoughts filled me with dread about what to do with the extremely difficult patient. What if the patient doesn’t like me? What if I bother my supervisor too much? What if I forgot to do a critical investigation?

So I went in this morning to the practice, all tensed up and nervous. I got the software training, and had a tour of the place. Can’t believe there is a CT scanner downstairs at the practice!

And when I got around to seeing my first patient, it wasn’t actually so bad. Having experienced ED at the hospital, the patients there had been very unwell, and it always felt like I was waiting for a consultant, and constantly waiting for someone to make a decision because I wasn’t experienced to make that call. And if patient’s had built up, the whole department got stressed, with team leaders pretty much yelling if you were too slow.

I didn’t experience any of that today fortunately. And the patients I saw were pretty lovely to be honest (which I guess I wasn’t really expecting working in a low socioeconomic status suburb).

My very first patient – menorrhagia after going off the implanon. This has been for 2 years since removal of the implanon. Should I put her on the pill, or should I refer her? When is the normal time frame after implanon removal when patient should have regular period again? All this I didn’t know, so asking the supervisor, he advised that I should refer her. And to do a speculum, since last one was done about 1 year ago when she had her pap smear.

And at the end of the day, I have a list of stuff I need to look up in more detail to fill my gaps in knowledge. Things like implanon contraception, hypertension management and investigations, and tinnitus.

My supervisor later told me how specialists would be well gunned for complex and really heavy illnesses, but for common things, would have no clue how to approach. He shared the example of a paeds consultant not knowing how to manage a child with VSD who got a simple finger laceration. The patient got stitched, and given gentamicin (which is overkill). But hey, in general practice, a good GP knows how to manage simple problems, and if its out of their scope or requires specialist intervention, a referral is appropriate.

In a way, that’s why I chose general practice. A specialist is excellent in their field of specialty, but for other things – they have no idea how to treat. A GP knows how to manage basic conditions for almost everything, but not to levels of expertise like a specialist. But for things like a rash or bump/lump, I can imagine the cardiologist telling a patient to “go and see the GP”.

Having worked in the hospital for the past 3 years, I can say that the first day of any of my rotations have not been as satisfying and bringing content as general practice.

Today was officially the last day of hospital. I was doing the dreaded postnatal checks (which I have done usually on Saturday, and those were busy as ever), so imagine my surprise when I went in today to find only 9 postnatal discharges (I have usually had to do 14- 18, with many ward call jobs as well in between).

By 12 noon, I had managed to see all my patients. Best day ever I must say. It has never happened before, and I am so glad that it happened on my last day of hospital.

Even the PAOU (pregnancy assessment and observation unit) was “quiet”, so they didn’t really need the help I offered them. So, I ended up spending 5 hours doing something productive like reading up stuff on medicare (prior to my orientation tomorrow), and some stuff on hypertension.

Also, today was a really nice day. Last few days have been muggy days with 33 degree temperatures. Today was a nice 27 degrees. Very pleasant.

Looking back at my 3 years in hospital, I can say that I’ve come a fair way. But being in training as of tomorrow, I have even more to go. Hospital time was stressful at times, but I can certainly say that I have learned a lot from it, and I am grateful to my patients, to my colleagues and the to the registrars and consultants who gave me great support and educational opportunities.

Before I left the hospital, I posted some internal mail to “Human Resources” with my ID badge, parking card and a letter written on a progress note.

“Dear Human Resources,

Please find enclosed my ID badge and car parking card.

I have had a wonderful time working here at the hospital.

Kind regards

The Placebo Effect

I dropped it off at the internal mails box, to never see my name badge ever again.

Leaving the hospital, I crossed the street, before deciding that I needed to take a photo of the hospital entrance, and so went back. Just like my last regional hospital, I don’t know when I’ll be passing the entrance again.

I race off to catch my bus, thinking that this is the last bus ride back home from the hospital. A nice finish to the day, and a nice finish to the last day in hospital. I need to pack my stuff up for tomorrow for… The start of orientation as a general practice registrar

The hospital system is the mash up of many different specialties, all with the common goal of patient centred care; people are sick, so they come to hospital to get better.

With these different specialties, comes different responsibilities, and if you overstep your boundaries and encroach onto a different specialty, there are legal liabilities. Hence, a physiotherapists providing medical advice about orthopaedic problems becomes a legal issue.

I understand why there are such legal liabilities, and in fact, I think these boundaries are necessary to protect patients. But having been in the hospital system, I think it can get pretty ridiculous at times. For instance, at the previous hospital I worked at, an ultrasonographer could mark out the level of pleural effusion, but would not mark the spot for fear of legal liabilities should any issues arise if it was drained. Hence the doctor (usually a resident) would need to come and mark the site that the ultrasonagrapher had indicated. So as a result, any issues with a drain insertion would be blamed on the resident, even though it was the ultrasonographer who technically marked out the site.

In a way, I feel that some of these legal responsibilities leads to a decay in upholding good moral standards. The other day I was asked by the nurse to come and console an anxious patient who had her belonging stolen by an outsider. It was a strange request, because what was I supposed to do as a doctor? I felt that a social worker would have been more appropriate. So I arrived and sat at the patient’s bedside, and started listening.

“Ms X, I’m sorry to hear about what happened to you. How are you feeling?”

“I feel terrible. This everything has gone missing including my phone and all my credit cards. I have at least 12 credit cards in my wallet!”

“Ok. Have you started trying to cancel your credit cards yet?”

“I have Westpac here in Australia, and all the others are in England. But I wouldn’t know how to cancel the cards.”

“Ok, maybe I can try and call the Westpac number and we can try and cancel the card.”

I went back to the doctors desk, and asked one of the nurses if social work was doing anything about cancelling the credit cards. Apparently, social work thought it was not their job to cancel credit cards, and declined to help (it was a Sunday anyway).

Anyway, the dect phone I was holding was too unreliable and kept cutting out, so I ended up asking the patient to come to the doctors desk to use the landline. Partway through, one of the surgical doctors asked me to come into a side office. When I got in, she stated firmly “You need to stop what you are doing. It’s not your role to cancel credit cards, and there are legal boundaries in helping her to do so.”

I had a think about this, and could definitely see where she was coming from. It looks sketchy to say the least when a doctor is helping a patient to cancel her credit cards. Almost like I could somehow financially benefit from the situation. I know I couldn’t do much for the patient aside from listening, so I thought the least I could do was to help her cancel her credit card to prevent someone from stealing her money.

In the end, her daughter arrived, and I quietly left the patient in the care of the daughter.

It frustrates me that because of legal issues, it prevents us from doing something decent. It’s something that I hear about to no end in China, where people are too afraid to help people on the streets who are hurt or ill, due to the fears of legal proceedings against them with false accusations.

But then again, in any system, if things like that are allowed to happen, then people end up changing. If the patient made a complaint against me, or if I was penalized for what I did for that elderly woman, I would be pretty stupid to do it all over again if something similar happens.

I remember my very first formal interview – it ended in failure. What made it so depressing too was that it was THE interview that my future depended on – medical school.

So having failed at that, I realized that either I was an immature 19 year old that lacked life experience, or that I lacked interview experience. I chose to realize the second option, and vowed that some day, I would be great at interviews.

Since then, I suppose interviews just happened. Interviews for entry into the GP program, some interviews for part time jobs. With each interview, I picked up basic skills, such as knowing what to say, and what not to say. I learned to never offer more information then was required to answer a question. And that advice has served me well.

It just so happens that on the 1st of June, all GP registrars could apply to practices for next year, and of course, this would mean submitting a CV, cover letter, and attending an interview.

So in my holiday in China, I spent a great deal of time updating my CV, looking back at the past 3 years and deciding what to put on my CV. I put effort into making it look neat, and to also demonstrate my well roundedness for GP (to my credit, I have done lots of different rotations including surgery, medicine, ED, psychiatry, Paediatrics, O+G and orthopaedics).

Having submitted my cover letter and CV for 5 different practices, I was offered 3 interviews. It was just a matter of preparation.

I think I may have over prepared for these interviews, since I anticipated questions asked, and thought of thoughtful answers to say. And then I reflected on past cases seen, and what I really wanted out of the practices I applied to. And research. Probably the most important thing was knowing about the practice I applied to.

It was a total pain trying to attend interviews when I’m on ED because of the weird rostering. So I ended up attending an interview even though I finished a night of ED. So, I rocked up probably with only 4 hours sleep.

In the end, I managed to get an offer from all 3 places that I interviewed at, which I was pretty impressed with, since I had failed so miserably in my first ever interview. The interviews were so easy compared to what I expected, and I felt a tad silly for overpreparing. But I don’t think one can ever overprepare for an interview.

Again, I stress the importance of research, because I was asked by one interviewer what I knew about their practice. And that’s when I said “I understand that your practice opens 365 days per year, and holds an excellent philosophical principle of providing affordable and accessible health care which is exactly in line with what I believe health care should be.”

In the end, I chose a practice that would be very busy and most likely stressful. But hey, at least I’d learn a lot from it. The supervisor even told me that he would “throw me in the deep end”, so I even got a warning that it was going to be stressful. But isn’t that how one grows and learns, by being outside of their comfort zone? So why not.

Fascinated by the Chinese culture, I had researched what it was like to be a doctor in China. My thinking was that if my Chinese was good enough, I could go to China to practice for a few months to a year or so, and develop more of my Chinese, as well as see how healthcare works in another country. I didn’t mind if my wages would be much lower, but it was the experience that would make the decreased wages worth it.

My research led me to see how fractured and weak the healthcare system in China was.

Doctors are overworked, and underpaid. A lot of doctors provided substandard health care as a result of an overwhelming number of patient demand that could not be met by the health care system. With a country that has over a billion people, it’s no wonder. Coupled with the fact that there has been a net migration of rural residents flooding into the cities, and this will burden the health care system a lot.

Last year, my grandma needed to pay a visit to the hospital as a result of what was likely an asthma attack. In the hospital, everything is based around the almighty dollar. A deposit of around 5000 yuan was required upon being admitted as a patient, just so that you will be able to pay for your medical fees. And what should happen if you end up spending all that 5000 yuan? You get refused medical service. My aunty managed to bargain with the doctor’s in hospital and was able to bargain the deposit down to 2000 yuan. But a couple of days as a patient, my grandma was not given her morning medications. When asked why, the nurse advised that her 2000 yuan deposit was all spent, and no medications would be provided until this amount was topped up.

Other things that seem to be wrong with the health system there, is the encouragement of the “hong bao” or red envelope. In China, a red envelope contains money, and is often given as a token of goodwill. For the rich in China, giving a red envelope gives them a sense that things can be accomplished more quickly, that the doctor will spend more quality time with the patient. My mum who had been to one of the hospitals had clearly seen a Chinese sign that states “No red envelopes allowed”, yet I’ve heard that this gets curtailed by the use of credit cards given instead that are loaded with money.

The way that the doctor gets paid is also shocking. Doctors seem to get paid for prescribing things. In that way, this ends up to a lot of unnecessary prescribing for the sake of earning extra money. My father who had gone to one of the hospitals because of an upset tummy and 1 or 2 episodes of diarrhoea was offered IV fluids. He wasn’t dehydrated or anything, and didn’t need the IV fluids. Why give someone something when the risks of infection from the cannula etc outweighed the benefits? Perhaps by giving IV fluids, it is relatively “safe” and makes good money as well, and in the minds of other patients, they think something is being done.

Finally, perhaps the most disheartening thing I’ve read, have been doctor killings from patients. A times article sums up this perfectly here.

It’s quite sad actually, but I’ve been told that being a doctor in China is not what people aspire to, given the great responsibility and little financial reward given. I don’t blame them given the way doctors are being treated there.

I remember having done paediatrics as a student and as an intern. Both times, I got sick. Probably for only about a week or so, but then I got better, so I could enjoy the rest of the rotation.

I’ve been doing paediatrics now for about 6 weeks. And I hate it. Well, that’s probably not entirely true. I like managing and diagnosing paediatric conditions, but I hate the germs and bugs that comes with the patient group.

Every second or third child is a febrile, coughing, runny nosed kid. With such a high exposure rate of flu viruses and bacterial infections, it was only a matter of time before I became sick. And sick I became. In fact, for a total of 3 weeks! Yes 3 miserable weeks of suffering!

Thinking back to it, the first time I got sick, I had to cancel dinner plans with a friend. I started feeling better over the next few days, but had to do a 4 day stretch of nights. And on the last night shift… I got a sore throat. So I get sick some more, with some laryngitis, hoarse voice and the like. Just as it’s improving …. I get unilateral throat soreness. I don’t think much of it, thinking it’s viral. But over the next 2 days, I become febrile, I get chills, I have extremely painful lymph nodes, and I think I can see some exudate in the back of my throat.

I only just started some antibiotics today, and it’s already helping a bit. My throat doesn’t feel so sore anymore. I just hope I don’t spike fevers again tonight.

I must be extremely unlucky with 3 successive episodes of throat infections. I think I’ll be extremely glad to leave paediatrics behind and to leave a miserable few weeks of illness behind as well.

Having spent 10 weeks in a busy medicine rotation, I am now on the dreaded ‘relief’ term – a term in which I could be in any department to relieve other resident medical officers who go on holiday.

What I absolutely dreaded was the idea of going back to surgery. The horrors of being in surgery a year ago were just too much. The idea of having to stay late, and to put in a tremendous amount of effort that largely went unnoticed was too much.

But having spent a week already in surgery, I’m actually starting to like it. The registrars are quite nice actually. The patient list is manageable at under 15 on most days (unlike the 30 patient list surgery constantly had last year). And the head of surgery from last year has left permanently (she tried to fail my mid term assessment for trivial reasons like having checked a patient’s bloods an hour late when they had a potassium of 5.0).

In addition, perhaps my skills really have improved. Last year, discharging 3 patients and managing the ward on my own was extremely challenging and stressful. I did all that a few days ago, with time left to help out at clinics, and then some more to attend a minor operations clinic.

I have just one more week of surgery, and there will be another person on the team, bringing the total count of residents to 5. Looks like next week won’t be too bad. After surgery – a few weeks of emergency medicine. I hope that goes smoothly as well.

For the past week, it has been extremely busy. I attribute this to the deck phone I’m holding, the patient load my team has, and just being unlucky.

Firstly, the deck phone; it’s a blocky black and grey phone, which vibrates, and plays a ring tone that makes me shudder in fear every time it rings. It’s constantly like a lottery, except it’s a lottery of bad luck. If I’m “lucky”, I might just get a call about giving a phone order for Paracetamol. If I’m “unlucky”, I might get asked to see a patient who has chest pains, or someone who is short of breath (as I was told to just this morning).

My deck phone is extremely efficient; at creating more work that is. For some reason, I’m always the one holding it, even though there is a registrar and another intern on the team. If the registrar borrows the phone to call someone, it will somehow always make its way back to me. Same with when the intern “borrows” the phone. It will be handed straight back to me. Perhaps the most amusing incident was this morning, when the registrar said to me “since you’re on phone duties, would you like to make the phone call for transport services to get this patient transported to the metropolitan hospital?” Since I’m on phone duty…. I never wanted to be on phone duty actually, but I’m always being handed the phone by you guys anyway.

On my first day on the team, I told the intern, “I’ll take the phone today, but let’s take turns holding the phones on alternate days.” Seems that somehow this conversation was forgotten. I suppose partly it is my fault in not enforcing this upon the intern.

Today was particularly bad however. As I got on the lift to see a patient downstairs, my phone rings. I need to put a cannula in a patient. The patient needs protective equipment used (gloves and gowns). Starting the procedure, and all gowned up, the phone rings. I am not allowed to answer the phone because I’m gowned up, and because I’ve already started the procedure. The phone rings once for about 20 seconds, and then hangs up. This is followed by another two times. I think that it must be urgent given how many times I was called. Is a patient dying? Finishing the procedure, I call back, only to find that I needed to write up some eye drops for a patient. 3 phone calls missed consecutively, just to write up some eye drops? My goodness, I am scared to find out how many times the phone would ring if I was unable to answer it, and it truly was for a patient that was sick/dying.

Aside from the deck phone, the patient load seems to be quite a bit lately. We’ve been getting a few patients with some being a little bit sick.

There was one patient that I had to see yesterday who was tachypneic. A very anxious elderly lady who was essentially palliative, having a left mid ureteric stone, urosepsis and end stage COPD. She was deemed too great an anaesthetic risk to have her kidney stone operated on. So, having tachypnea of 32, and then later finding out her phosphate levels were critical, and then later finding out her troponin was elevated presented a major nightmare. In addition, the consultant wanted CTPA (her kidneys were too shot to be safe for the contrast) and the patient had refused a V/Q scan. So not really knowing, I ended up just putting the patient on therapeutic clexane. But wait, the patient had haematuria a few days prior….

When I saw the patient yesterday with her daughter, I explained to her about her deterioration, and why I was giving her IV phosphate. She asked me if I could euthanize her yesterday. She still asked me if I could euthanize her again today. I had to politely explain to her that in Australia, euthanasia was illegal, and I certainly was not going to euthanize her. I ended up phoning my consultant for further management, and spoke to the ICU reg in regards to placing the patient on CPAP. I suppose the patient appreciated that I was doing what I could to help settle her SOB and tachypnea, and when my consultant came around, she told him “this doctor is really good, he’s been running around everywhere to help me”. That was perhaps one of the more uplifting moments for today for what was a relatively crappy day.

It was about 3:45 pm, and my back was aching from the busy day. Just one more patient to see. But upon seeing the final patient, they seem to have had it for me. The patient had been on isolation precautions, given that she could have had respiratory viruses. Having been visited by masked nurses, and told to stay in bed likely, I can understand the patient’s frustruation. I was just unlucky enough to come in and get blasted to smithereens by this patient’s frustration.

When it comes finally time for home time, I decide to check my email and find out the new updated roster. The person doing the rosters had decided to put me working on Sunday now, without contacting me at all. It’s almost like I’m indispensable, and not doing anything on Sunday. I email her, and tell her that I already had plans on Sunday, and to schedule me in on such short notice, the very least she could have done was call me first. Yea, I doubt I’ll have this coming Sunday off. Best crappy end to the day of a very busy day.

Now, onto the dreaded tomorrow; the intern will be off tomorrow, so it will be just me and the registrar…. I really need that Sunday off….

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I'm a male in his mid twenties working as a junior doctor. I'm passionate about medicine, and I love studying Chinese
I blog about medicine and life in general, because it's an outlet for me to express myself, and it helps me to put my thoughts into perspective.